Communications: Advocacy News

Two Weeks to Go in Legislative Session and Action Moves Behind Closed Doors

Thursday, May 11, 2017   (0 Comments)
Posted by: Dave Renner, CAE, MAFP Legislative Representative
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With two weeks to go in the 2017 legislative session all focus has shifted to final budget negotiations.

The House and Senate have reached agreement on the health and human services budget bill that cuts $505 million from expected spending, but that level of spending has not been agreed to by Governor Dayton.

In the Higher Education budgets the legislature did agree on increasing funding for the University of Minnesota family medicine residency programs by $5.25 million in 2018, growing to $7.25 million in 2019. This funding is critical to ensure the number of family medicine residency slots in the University’s programs. This was also in Gov. Dayton’s budget recommendations, so hopefully that will not be a sticking point in final negotiations.

For the legislature to finish on time all three sides must come to an agreement on all of the budget bills before the deadline of May 22. Should the leaders not meet agreement on budget bills that the Governor will sign, a special session will be necessary.

Congress Passes AHCA, Outcome Uncertain in Senate

The House of Representatives passed the American Health Care Act on a 117-113 vote on May 4, 2017, achieving their promise to pass a “repeal and replace” of Obamacare. The bill now goes to the US Senate where it is unlikely it will pass in the current form.

The ACHA allows states to obtain waivers from some of the insurance underwriting limits that exists in the ACA and creates new caps on Medicaid funding that will harm state’s like Minnesota. The waivers will allow states to charge patients more it they have pre-existing conditions and exempt coverage from the essential benefits passed by Congress. Critics of the AHCA, including the AAFP, argue that it will result in millions Americans losing health coverage while others will face escalating premiums and deductibles.

The Senate rules require 60 votes to pass any reforms so it is unknown whether they will be able to develop a compromise bill that House Republicans will be able to support.

HHS Budget Conference Committee Agreement Unveiled

The House and Senate conference committee tasked with negotiating a single health and human services bill released its budget proposal on May 1. That agreement will now be presented to Governor Dayton as they negotiate a final bill. The conference committee is chaired by Rep. Matt Dean (R – Dellwood) and Sen. Michelle Benson (R – Ham Lake). The two DFL members of the conference committee voiced their strong dissent with both the process that the conference committee used, as well as the content of the proposal.

The HHS bill put forward by the conference committee cuts more than $500 million from projected spending for the 2017-2018 fiscal year. It does so largely through budget maneuvers that push spending into the 2019-2020 fiscal year, as well as saving more than $150 million by disregarding inflationary increases within the Medical Assistance payments in future forecasts. This disregard could put Minnesota out of compliance with federal requirements to pay actuarially sound rates.

One positive with the proposed agreement is this is does not include cuts to physician reimbursement under Medical Assistance and MinnesotaCare that were in earlier versions of the House and Senate spending proposals.

The nearly 600-page document contains hundreds of policy and spending provisions, including funding increases for mental health programs, grants for opioid awareness and abuse prevention, the creation of a palliative care advisory council, funding to support Honoring Choices, support for food shelves, foster care investments, and many more.

Regrettably, the bill does not contain the prior authorization language that had been sought by physicians groups and patient advocates. That language had received broad and bipartisan support in the Senate and was included in their budget proposal, though the House has blocked a hearing for the proposal. Also excluded from the budget package is a provision that sought to require alignment between state and federal quality measures. That language was included in the Senate proposal, and had cleared the House committee process without opposition.

Higher Ed Budget Bill Includes Family Medicine Residency Funding

The House and Senate reaching agreement on the Higher Education budget bill to begin negotiations with Gov. Dayton on a final bill. Good news is that it includes the increased funding request for the University of Minnesota’s Family Medicine residency programs. Because of the loss of UCare revenues over the last few years the University was forced to cut the size of the North Memorial program by two residency slots.

The request this year was to increase state funding for these programs by $5.25 million in 2018 and $7.25 million in 2019. The House and Senate has agreed to that amount and it was included in the Governor’s original budget request.

This has been a priority to the MAFP and we are glad to see it moving forward. While not for sure yet, we are hopeful it will be agreed to by all sides.

Efforts to Elevate Vaccine Awareness Fails on House Floor

In response to the measles outbreak that started in Minneapolis and and has spread to other parts of Minnesota, Rep. Ilhan Omar (DFL - Minneapolis) introduced HF 2630 on May 1. The bill would provide $500,000 in funding for vaccine education programs focused on populations with low immunization rates. The Senate companion bill is authored by Sen. Jeff Hayden (DFL – Minneapolis).

Rep. Omar attempted to expedite action on the bill on the House floor by using a procedural motion that would have pulled the bill out of committee and brought it up for consideration immediately. She and other argued that the measles outbreak required immediate action. Opponents argued that the bill should be considered in the regular order of business, and that it lacked specificity. The procedural motion failed on a largely party-line vote.

Rep. Omar is the first Somali-American legislator elected in the United States.

“Tobacco 21” Introduced in the State Senate

An effort to raise the minimum age at which an individual may purchase tobacco products took its first steps in the State Senate on May 4 when it was introduced by author Sen. Carla Nelson (R - Rochester). The bill, SF 2370, makes sales of tobacco products to individuals under 21 illegal. The bill also requires additional signage regarding the minimum retail establishments where tobacco products are sold, similar to existing laws that govern the sale of products containing alcohol.

Leading the effort to pass the legislation is the Minnesotans for a Smoke-Free Generation, of which the MAFP is a member. The bill was introduced this legislative session as a way to raise awareness and build momentum towards passage in subsequent legislative sessions.

The bill's introduction comes on the heels of the city of Edina's passage on May 2 of a landmark city ordinance to raise the minimum age to 21. While the bill will not move forward this year, as additional cities across the state hopefully consider similar proposals this year, it is hoped that eventually the state will pass a statewide law. More than 200 municipalities across the country have adopted tobacco 21 ordinances, as have Hawaii and California.

Senator Nelson is joined by coauthors Sen. Jeff Hayden (DFL - Minneapolis), Melisa Franzen (DFL - Edina), and Erik Simonson (DFL - Duluth). A House companion bill has yet to be introduced.

Fix to the Interstate Medical Licensure Compact Clears Senate

An effort to provide a technical fix to the statute governing Minnesota’s membership in the Interstate Medical Licensure Compact cleared the Senate on May 4 by a unanimous margin. The bill, HF 474, authored by Sen. Carla Nelson (R – Rochester), clarified Minnesota’s criminal background check laws to allow Minnesota to enter the Compact as intended when the original bill was passed in 2015. The fix was required, because the federal law enforcement officials had determined that the original language did not comply with the federal law related to criminal background checks. The bill has already passed the House unanimously, but must go back for a final action because of changes made to the Senate version. It is expected to pass again.

The Interstate Medical Licensure Compact is a collection of states that have partnered to ease licensure for physicians who wish to practice in multiple states. Currently passed in 19 states, Minnesota passed the original legislation in 2015 in a unanimous vote.

Tobacco Provisions Included in Budget, Tax Bills

In other tobacco news, the Health and Human Services budget conference committee bill includes state funding for the state’s “Quit Line” cessation services. This funding is needed because the funds from the state’s landmark law suit will be ending soon. While a good program worthy of state investment, the legislature recommends that funds be diverted from the state’s Statewide Health Improvement Program (SHIP) to fund it, effectively reducing the SHIP appropriation.

The tax conference committee bill also includes a provision favorable to the tobacco industry, as it repeals the automatic inflationary increase to the tobacco tax that was included in the 2013 tobacco tax increase legislation. The current law increases the tobacco tax with inflation, and repeal of the inflator is a priority for the tobacco industry.

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